AMA puts flawed PCEHR on the mend

When his sister was lying unconscious in a hospital intensive care unit, it was driven home to Adelaide GP Dr Chris Moy just how important an accurate electronic health record could be.

“I asked the treating doctor how often do you get a patient’s medical history, including the medications they are on, their allergies and diagnoses, and he said ‘Never’,” Dr Moy recalled.

At the time, he was heavily involved with HealthConnect SA in developing an electronic care planning system for elderly patients.

“A by-product of that was that we were developing a prototype of the electronic health record,” he said.

The project was killed off prematurely when the global financial crisis hit in late 2008, bringing an abrupt end to the funding.

But it left an indelible impression on Dr Moy, who saw the potential for e-health to vastly improve health care and potentially save thousands of lives a year, by ensuring practitioners at the point of service had access to vital patient information such as medications, allergies and previous diagnoses.

So it was with mounting frustration and dismay that he, along with much of medical profession, watched as the Federal Government made basic blunders in building and introducing the Personally Controlled Electronic Health Record (PCEHR).

When he was approached by AMA officials last year to become involved in efforts to address problems with the PCEHR and turn it into something useful for clinicians and patients, Dr Moy was initially reluctant.

But the chance to help realise the potential of e-health to save lives and improve care convinced him to make the commitment.

A little more than 12 months later, he believes the AMA has achieved real progress toward turning the PCEHR from an IT-driven system with little appeal or usefulness for practitioners into something with real and practical benefits for both doctors and patients.

But it hasn’t been easy.

“The whole project had gone off track,” Dr Moy said. “It was being driven by IT people and programmers, and I could see that they were ballsing it up.”

He said they had developed the system with no understanding of how clinicians worked – a huge oversight given that it was doctors (mostly GPs) who would be creating the health records and bearing any risks arising from incomplete or incorrect information.

“I am not an IT person, I am a work flow person, and the program managers and IT people did not understand workflow.

“They did not understand that the way that doctors are going to interact with the PCEHR is through the GP desktop system.”

Through his work on the Department of Health and Ageing PCEHR Independent Advisory Council, combined with the efforts of other AMA officials – not least President Dr Steve Hambleton – progress is being made to turn the PCEHR into a practical and useful system.

This has included urging the development of a one-button navigation system for the PCEHR on GP desktop systems; trying to ensure the desktop PCEHR software packages each have a similar look, feel and work flow; promoting the development of demonstration PCEHR models to help doctors familiarise themselves with how it would look and work; and institute a moratorium on the addition of new features until the basics of a practical and usable system for doctors and patients are established.

“We don’t need to start again, but we need to make it useable, and our goal is to make sure that clinicians get to develop the workflow of it,” Dr Moy said.

He admitted that there was a considerable way to go, but said progress was being made, and urged sceptics to withhold judgement.

“People think I am completely nuts [to have got involved with the PCEHR], but I am still in it because 3500 deaths a year caused by poor [medical] information could be avoided if we get this right, as well as millions of adverse events, inappropriate resuscitations and so on.”

Among his biggest concerns are the myths and misconceptions held by many regarding the PCEHR, particularly about the ability of patients to alter shared health summaries.

He admitted that, for political reasons, patients and privacy activists had won out over doctors in the tug of war over who would control the health record.

But Dr Moy said this was not the fatal flaw that some claimed it was because – contrary to the myth – patients could not change a shared health summary once it had been created.

“Once a doctor and patient have sat down together and created a shared health summary, the patient can’t go back at a later date and decide to delete, say, a herpes diagnosis. Their only option is to delete the entire health summary.”

Dr Moy said the creators of the PCEHR had only themselves to blame for such misunderstandings.

“This is a huge myth out there, and the reason why such myths are out there is because there is no demo version out there,” he said.

He admits it is likely to be a long and slow process to get the medical profession to accept and embrace the PCEHR, but Dr Moy believes that by making it useful and easy to use, it will gain acceptance – with a massive pay-off in lives saved and unnecessary harm averted.